Use of P wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis

摘要

Background To investigate the changes of P wave indices in atrial fibrillation (AF) patients after catheter ablation and the association between P wave indices and AF recurrence. Methods PubMed, Embase, and Cochrane Database were searched through September 15th 2021 for studies on the association between P wave indices and AF with catheter ablation. Heterogeneity was estimated using the I-2 statistic, the random effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) was used to evaluate the predictive value. Results Among included fourteen studies with 1674 AF patients, we found significantly decreased P wave dispersion (P-dis) (mean difference [MD]: - 6.5 ms, 95% confidence interval [95% CI]: - 11.81 to - 1.18, P = 0.02) after cryoballoon ablation (CBA) or radiofrequency ablation (RFA), and maximum P wave (P-max) (MD: - 8.57 ms, 95% CI: - 17.03 to - 0.10, P = 0.05) after RFA only, but increased minimum P wave (P-min) (MD: 3.43 ms, 95% CI: 1.07 to 5.79, P < 0.01) after CBA only. P-dis measured before ablation was remarkably higher (MD: 5.79 ms, 95% CI: 2.23 to 9.36, P < 0.01) in patients with recurrence than without; meanwhile, P-max was higher measured both before and after ablation (MD: 6.49 ms, 95% CI: 2.30 to 10.69, P < 0.01 and MD: 11.2 ms, 95% CI: 2.88 to 19.52, P < 0.01). Furthermore, SROC analysis showed acceptable predictive efficiencies of P-dis (AUC = 0.776) and P-max (AUC = 0.759) for AF recurrence. Conclusion P-dis was significantly decreased after AF catheter ablation. Higher P-dis and P-max may have predictive values for AF recurrence.